Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: A systematic review and meta-analysis

Cluxton-Keller, Fallon; Bruce, Martha L.

doi:10.1371/journal.pone.0198730

Cited by 47 publications

(57 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is a scarcity of research on the use of HIPAA-compliant video-based communication technology to deliver family therapy for treatment of perinatal depression in rural regions of the United States. The studies that have been conducted on this method of delivery focus on family therapy interventions for behavioral problems in children [41-44], but none have targeted perinatal depressive symptoms in young mothers with family discord [45]. The video-delivered family therapy intervention presented in this study is unique in that it addresses individual-level and family-level cognitive, emotion, and behavior regulation.…”

Section: Discussionmentioning

confidence: 99%

“…The use of Health Insurance Portability and Accountability Act (HIPAA)–compliant video-based communication technology is not novel in rural areas and ample evidence supports its use (eg, [39,40]). Studies have been conducted on video-delivered family interventions for some populations [41-44], but none have targeted perinatal depressive symptoms in home visited mothers [45].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial

Cluxton-Keller

Williams

Buteau³

et al. 2018

JMIR Ment Health

Self Cite

View full text Add to dashboard Cite

BackgroundThe Federal Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention strategy that serves families at risk for child maltreatment throughout the United States. Significant portions of the clients are young mothers who screen positive for clinically significant perinatal depressive symptoms and experience relational discord that worsens their symptoms. Although home visitors refer those who screen positive for depression to community-based treatment, they infrequently obtain treatment because of multiple barriers. These barriers are compounded for home visited families in rural areas.ObjectiveThis pilot study aimed to explore the feasibility, acceptability, and effectiveness of a video-delivered family therapy intervention on reducing maternal depressive symptoms and improving family functioning and emotion regulation.MethodsA total of 13 home visited families received the video-delivered family therapy intervention. This study included a historical comparison group of mothers (N=13) who were previously enrolled in home visiting and screened positive for clinically significant perinatal depressive symptoms but refused treatment. A licensed marriage and family therapist delivered the family therapy intervention using Health Insurance Portability and Accountability Act–compliant videoconferencing technology on a computer from an office. Families participated in sessions in their homes using cell phones, tablets, and computers equipped with microphones and video cameras. Outcomes were measured following the final therapy session (post intervention) and 2 months later (follow-up). Depressive symptom scores of mothers who received the video-delivered family therapy intervention were compared with those of mothers in the historical comparison group over a 6-month period. Univariate statistics and correlations were calculated to assess measures of feasibility. Percentages and qualitative thematic analysis were used to assess acceptability. Wilcoxon signed-rank tests were used to assess changes in maternal and family outcomes.ResultsNo families dropped out of the study. All families reported that the technology was convenient and easy to use. All families reported high satisfaction with the video-delivered intervention. Nearly all families reported that they preferred video-delivered family therapy instead of clinic-based therapy. Therapeutic alliance was strong. Mothers demonstrated a statistically significant reduction in depressive symptoms (P=.001). When compared with mothers in the historical comparison group, those in the family therapy intervention showed a significant reduction in depressive symptoms (P=.001). Families demonstrated statistically significant improvements in family functioning (P=.02) and cognitive reappraisal (P=.004).ConclusionsThis pilot study yielded preliminary findings that support the feasibility, acceptability, and effectiveness of the video-delivered family therapy intervention for underserved home visited families in rural areas. Our finding...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial

Cluxton-Keller

Williams

Buteau³

et al. 2018

JMIR Ment Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…Possible approaches that merit further exploration include: (i) considering how to adapt current practice to make it more family-friendly (eg, by identifying acceptable ways to include partners/relatives more meaningfully in (at least some) appointments), (ii) challenging the way service structures currently deprioritise family members’ needs, but also balancing this with protecting women’s needs, (iii) developing or adapting couple or family-focused interventions for perinatal populations: previous reviews suggest that family therapy can help address and prevent perinatal depression,29 30 and that couple psychoeducation can support the transition to parenthood 31. In England, clinical guidelines recommend couple or family approaches for some perinatal mental health difficulties,14 but such interventions are rarely available and have not been extensively tested in the perinatal period22, (iv) developing and testing resources/interventions aimed at women’s partners and wider families, acknowledging that some will themselves also have perinatal mental health needs: this will need to take into account that some family members express a preference for more ‘informal’ or ‘incidental’ forms of support (though this also may be partly a result of services treating them as ancillary) and (v) trialling specific staff training around engaging with families in the perinatal period, including awareness of cultural diversity.…”

Section: Discussionmentioning

confidence: 99%

Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England

et al. 2019

View full text Add to dashboard Cite

ObjectivesPartners and wider family members play a vital role in relation to women’s perinatal mental health. Clinical guidelines in the UK and internationally recommend that services supporting women with perinatal mental health difficulties involve and support their families too. However, little is known about family members’ needs and experiences, or whether they feel included by mental health services. This study set out to explore this.MethodsThis research formed part of a wider study exploring experiences of perinatal mental health care in England. The broader study included semi-structured interviews with 52 women across England who received treatment for a perinatal mental health difficulty, and 32 family members identified by the women as offering them some support. Data from these 84 interviews relating to how services work with partners and families were extracted and analysed thematically.ResultsAnalysis identified three overarching themes: (1) the centrality of women’s families to their perinatal mental health/access to support, (2) experiences of partners and families being excluded by services and (3) ambivalence among women and their families about increasing family involvement/support. We found that partners and families appear to have an important influence on women’s perinatal mental health, access to care and interactions with services, but that services tend to focus on individual women (and babies) with little regard for their wider family context. The complexity of involving and supporting partners and families, coupled with anxiety about this among women and their families, reinforces the tendency to marginalise them.ConclusionInvolving women’s families and providing the support they need is challenging, but important. Experiences of women and their families of services treating perinatal mental health difficulties suggests greater focus is needed on overcoming barriers to family inclusion and on challenging underlying gender roles and expectations, rather than allowing these to shape and guide practice.

show abstract

“…An alternative approach is family interventions. A recent systematic review found two small treatment trials of couple interventions which were associated with improvements in maternal depressive symptoms 167 . As with research into maternal interventions, a core outcome set would be useful to improve methodological rigour.…”

Section: Interventionsmentioning

confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

View full text Add to dashboard Cite

Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high‐income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.

show abstract

Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: A systematic review and meta-analysis

Cited by 47 publications

References 62 publications

Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial

Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial

Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England

Perinatal mental health: a review of progress and challenges

Contact Info

Product

Resources

About